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Federal forms, ICRs, and supporting documents

Information Collection

OPTN Membership Application for Heart Transplant Program

IC 226684 under ICR 202512-0915-001 · OMB 0915-0184.

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Information Collection (IC) Details

View Information Collection (IC)

OPTN Membership Application for Heart Transplant Program
 
No Modified
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 5 OPTN Membership Application for Heart Transplant Programs 05_OPTN Membership Application for Heart Transplant Programs_CLEAN.docx Yes Yes Fillable Fileable

Health Health Care Services

Organ Procurement and Transplantation Network (OPTN)/ Scientific Registry of Transplant Recipients (SRTR) Data System, HHS/ HRSA/HSB/DoT, 09-15-0055  87 FR 46967

155 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 39 0 -10 0 0 49
Annual IC Time Burden (Hours) 656 0 -349 0 0 1,005
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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